Financial Inequality "The 99%" and why Nurses Should Care

One big issue in our nation right now is the level of financial inequality. You may have heard that the wealthiest in our nation control an exorbitant amount of money but
Why should this matter to nurses?

The truth is that this extreme polarity is much worse than most people realize.

Watch it! You will find that you couldn't even comprehend!



Ok so why should this matter to nurses?

We do alright and who am I to say that another shouldn't succeed?

The truth is that Extreme Financial Inequality is inversely correlated with almost every negative

health concern, social problem and vital issue that is hurting our nation!

Richard Wilkinson Presents the Evidence in this Excellent Video.

At least check out the first few minutes it will make a lot of sense.




I especially loved the part where he discusses how it doesn't matter how we get there it only matters that we do.

It also was very eye opening how the level of wealth in a nation compared to other nations doesn't really matter.

This means we need to lose the idea that we need to grow our economy and start to
Balance and Heal our economy!

What Fuels your Innovation?

Ellen 't Hoen: Pool medical patents, save lives.

        This is an intriguing video I can really identify with. I have stated in earlier posts how the "business" of health care can detract from patient outcomes. I have also discussed how publicly funded research is far more beneficial to society as a whole. This video confirms my feelings and goes much farther in depth. Please Enjoy, Thanks.

Interview Process No Nos

      With Graduation and the impending job search looming it is nice to find a little comfort in some early preparation. If there is one thing I have learned in nursing school it is that preparation is the key to overcoming almost every anxiety producing endeavor.

With this in mind I have read and summarized an article by Hannah Morgan of U.S. News that I found to be very helpful.

This article is about improving communication in the job seeking and interview process. The author outlines three common mistakes to avoid, including:

          1- Confessing the irrelevant

          2- Interview Mishaps

          3- Overstating Generalities

She goes into depth on each of these three topics as well as emphasizing the important alternative to these mistakes.

Confessing the Irrelevant is something to avoid. It is not required to say, "I was laid off for this reason in 2002" or be overly forthcoming with information that makes you look bad. You do not want the employer feeling sorry for you or looking at you in a negative light. There is plenty of time for that after you get the job. It isn’t dishonest to withhold information that is irrelevant (Morgan, 2012).

        Fixing this entails focusing on your strength and the quantifiable contributions you have made in the past. You want to capture attention and keep it short and sweet.

Interview Mishaps should be avoided as well. Primarily this means overly focusing on your own needs and wants.

Examples Include:

-expressing dissatisfaction with payment/salary when asked.

-expressing a delay surrounding the timetable for starting the position.

-extreme scheduling concerns.

        Fixing these revolves around showing the employer that you are serious about the position and can make it the priority. Tell them what they want to hear, anything else can be construed as hesitancy or lack of interest (Morgan, 2012).

Lastly and Possibly Most Important

        Generalities Don’t Set You Apart. While it is good to use specifics from the job description in your resume and application it doesn’t help to state unquantifiable generalities that don’t set you apart.

Examples Include:

-Great team member

-Problem Solver

-Interpersonal Communicator

        Fixing this is done by stating what you have done, things that set you apart, projects and successes that are quantifiable and provable. Line up the companies specific interests with your specific skill set and the evidence supporting your skill set (Morgan, 2012).

An example from My life:

         Instead of stating Class Representative, while that may sound impressive, I would say Collaborated with faculty and other student leaders in revising the Clinical student/teacher Evaluation process. Helping to ensure students receive the critical feedback they need for success and ensuring the high standards of the CCNE accreditation were met.

        

        While this may sound like overkill it is accurate and quantifiable. I shared in depth at a meeting regarding this topic and while I didn't write any policies I feel strongly that I contributed to the process. A class representative who had not done so would not be able to quantify their participation in such a manner.

Morgan, H. (2012). Search With Style: 3 Ways to Improve Communication in a Job Hunt. Retrieved from:

http://money.usnews.com/money/blogs/outside-voices-careers/2012/09/19/search-with-style-3-ways-to-improve-communication-in-a-job-hunt

RN TLC (Teamwork, Leadership, Collaboration): "Always do what's in the best interest of the pati...

RN TLC (Teamwork, Leadership, Collaboration): "Always do what's in the best interest of the pati...: Marie Manthey, MNA, FRCN, FAAN This week we attended our Minnesota School of Business/Globe University's Annual Nursing Forum...

My friend Nikki's Awesome Post. Some People are Just Born to be Nurses I think. (Click on the Blue Link to her Page or right here)

Break Out the EEGs OMG

Wow it is these kinds of breakthroughs that we can point too whenever funding for research is limited or a problem seems too overwhelming.

In nursing our job is to advocate for these patients. How do we get them access to this technology?
How do we make them aware? Make our hospital aware?

Until it is mass incorporated it wont be cost effective. As nurses it is our job to push through this finacial resistance and achieve the best for our patients.

Awareness has to come first. There may be a faster more accessible way to differentiate underlying problems but until awareness is raised providers and patients wont know to look.

Leadership and Dynamic Adaptation

       In a recent School Wide Nursing Forum a speaker brought to our attention the fact that in Great Britain, Nurses frequently have complete control over patient diet and activity levels. This made me curious as to why Nurses aren't able to take control of certain aspects of care when it is warranted. The fundamental change would likely have to come at first in the curriculum and research into the practice of nurse run nutrition programs etc. But what prevents this change in healthcare or really any change in healthcare that may be for the better.

In the British Journal of Healthcare Management, Joanna DaCosta writes, "The traditional hierarchal model of postgraduate medical training is not conducive to developing practical leadership skills among
doctors and does not support change and innovation. Medical professionals should actively
promote the development of leadership skills amongst their more junior colleagues with a
particular emphasis on collaborative working across professional boundaries" (Dacosta, pg 575, 2012)

Now this may seem like an attack on traditional medicine, provider models of care or doctors in general but in reality it is none of the above. The author goes on to emphasize the need for Dynamic Adaptation and how to foster a Dynamic Environment. (Dacosta, 2012).  If there is one thing I have learned about leadership this quarter it is that the preconceived notions I had about leadership were false. In my mind a leader gave orders and in turn had responsibility for the overall success of any undertaking. A leaders job is actually to do everything in their power to ensure that all have a responsibility for the outcome and a desire to see that outcome to be a positive one. In patient care the outcome is often a life that hangs in the balance right? Ultimately a more effective model of care saves more lives doesn't it? I may be misunderstanding things or thinking too black and white but ultimately leadership contributes to this balance somewhat of that I am sure.

The author goes on to outline transactional and transformational leadership, one focused on negotiation and the other focused on promoting "followers [that] are both emotionally and rationally inclined to contribute more to a task than originally planned" (DaCosta, pg 576, 2012).

For innovation and growth to occur "an environment of 'psychological safety' that fosters risk taking and opportunism, and supports others to learn and adapt" (Dacosta, pg 579). If we want to solve the system wide issues in healthcare we must create this environment. We need to draw on the experience and ideas of all. As nurses we can lead the way in fostering leadership within our profession that is Progressive, Dynamic and Adaptive.

I would like to thank Marie Manthey the amazing nurse and amazing woman who came and spoke to our school at the forum. I was lucky enough to attend a Nursing Salon Marie held and it is people like her who continue to contribute and care in an immeasurable and immense fashion that are able to truly make a difference.










DaCosta, J. (2012). Leadership models for healthcare improvement. British Journal Of Healthcare Management, 18(11), 575-580.

Diarrhea and Domesticating Germs

   I really enjoyed this video. It really shows how big out of the box thinking can start to solve problems that seem unsolvable. For me that is what it means to be a leader. Thinking Big.

      In this video Evolutionary Biologist Paul                   Ewald talks about how limiting transmission    actually causes pathogens to evolve into less   harmful or "Domesticated" versions of   themselves.

           This could revolutionize how we view disease treatment and put and end to the progression of medication resistant drugs.


I know that sometimes we all have a tendency to just accept the problems of the world as endemic or overwhelming. It is true leaders like this gentlemen that make me want to believe in the solution.
                   

Case Management and Patient Centered Care

One of the prominent topics covered in this week’s reading was patient case management. The nurse's role as a case manager or coordinator of care has expanded significantly over the last quarter of a century (Huber, 2010). With the decline of general practitioner MDs and provider-to-patient ratios increasing, the case management role is one that we, as nurses, must continue to develop. Assessing patient needs and information will become more critical than ever as the Affordable Care Act comes to fruition in the coming years.

One important aspect of the Affordable care act that will be going into effect is a bundled payment per beneficiary policy.  This is officially referred to as Efficiency of Care, one of the Care Measures to be instituted. More important is the bundling payment time period that will stretch 3 days before a hospitalization or clinic visit to 30 days following discharge (Cesta, 2012).

This is important to case management because there is now a financial benefit and imperative to efficiency. Let’s say a man goes to the clinic with a fever and they run a CBC. Later that night the man goes to the ER and another CBC is performed. This second test lends no new diagnostic information, yet under the current system these providers are rewarded for their redundancy. The clinic and hospital bill separately for their services, even if they are both under the same umbrella health system.  Thus, they profit twice from duplicate testing. The patient has double the number of invasive procedures, higher potential for site infection and has to spend that much more time around potential nosocomial infections. Under the new system these redundancies will be decreased and patient care will improve. Medicare will still likely pay for services rendered within reason but they will now be able to pay attention to Efficiency of Care and assess how institutions measure against one another (Cesta, 2012).

Increased case management and communication will be required to institute this new level of efficiency. My hope is that the end result of increased case management is a higher level of patient centered care. After everything is running smoothly that the extra time saved by not repeating tests gives a provider the time and resources to order that screening that saves a life. I would like to work in a system that offers more that just treatment for the most severe conditions. I believe we can get there as a nation if we focus on attempting solutions as opposed to profiting off of the loop holes.


Cesta, T. (2012). The Role of Case Management in an Era of Healthcare Reform -- Part 3. Hospital Case Management, 20(9), 135-138.

Huber, D. (2010). Leadership and Nursing Care Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

Mentoring and Networking: Two win wins

       Mentoring and Networking are two key tools of leadership that I think are under valued by my generation. Growing up around such readily available technology and information to me there seems to be a shift among young people towards self-reliance and independent thought. As we start to move into the job market some of these skills that may have come more naturally to generations before need to be developed. In nursing especially, with a large percent of nurses set to retire in the coming years, the wisdom of these nurses must be retained.
     How do we find a mentor or where do we start? The answer is to find someone with the a high level of expertise in your area of interest. It shouldn't be approached like a friendship or anything other than what it is, a critical need for the knowledge and expertise the mentor has. According to Huber "the closer the link between the employee's needs and the mentor's competencies, the more likely it is that the mentorship will be productive" (Huber, p.724, 2010). We can use this to think about how to initiate a mentorship upon entering the field. What are we struggling the most with and who is the best at it. Well we might have a hard time working with patient families. In this case we could seek out a family therapy specialist or a family oriented home care nurse. We could seek out someone on the unit we work on that deals with families in the exact same capacity only does it extremely well. As long as we line up our honest need with their expertise there is a good chance it will work out. We can remember that there is a good chance they didn't get to where they are by magic. Likely any potential mentor has those who helped them along the way and most are happy to give something back. It speaks to the value of their knowledge and expertise when people specifically seek it out and the relationship that develops can be a continued source of validation and reassurance for both.

     Networking is something that, until recently, I didn't understand how mutually beneficial it was. Just through articulating your passion and drive to work with a specific company or in a specific capacity before the position is created you set yourself apart form those just looking for a job. Employers know the value of having employees who aren't just seeking a paycheck and what a difference it makes to have passionate team members. As nursing students we have this passion and if we make it known through networking the likelihood that we will get where we want to go when it is available to us increases dramatically.
     One thing I recently learned in another class related to networking is to think big. With this in mind I just sought out Diane Huber, the author of our textbook on Linked In. I saw in the about the author section that she went to the University of Iowa. There is the connection and I have found how she could aid my passion. I have grown up a huge Iowa Hawkeyes fan and my father went there for Law School. I would love to pursue my DNP or Nurse Practitioner's degree there someday and I know what an outstanding nursing university it is. Imagine the commitment and passion she would know I have for that institution if I reached out to her probably at least a full 5 or 10 years before I am planning on attending. I also really value her work and know what a great assest she would be to me as a mentor if I am ever awarded a leadership position. Of course I couldn't find her on there, it doesn't always work out like you would wish.

     The same holds true in networking as it does in mentorship nobody got where they are alone. We all need referrals and there is a desire for assisting those that are as sincere to follow in your footsteps or join your institution. I want the best future students attending MSB and would assist anyone I felt deserving in entering our program. 

       Considering what we are bringing to the table in either mentoring or networking we can proceed with confidence and knowledge of the true win-win scenario that is Mentoring or Networking.



Huber, D. (2010). Leadership and Nursing Care Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

Controlling the brain with Light...and RN leadership?

Dr. Karl Deisseroth of Stanford University Speaks on his amazing research.

       Just a heads up this video is a little bit long and kind of dry especially if you aren't as interested in science, science fiction, and psychology as I am. I included it in this my RN Leadership blog because the speaker, Dr. Karl Deisseroth of Stanford University, does a few key things in the last few minutes of the video that I found to be excellent examples of leadership.

       He describes throughout the video his groundbreaking research utilizing rare bacterium, archaea and fiber optics to make ground breaking strides in the treatment of brain disorders. Ok yada yada yada big deal right. Amazing man, amazing work, but why is it in a nursing blog?


Leadership Connection

       If you watch the last three minutes he does two things. First he gives credit to those who came before him and made his research possible while at the same time making a case for the importance of scientific research in general. He also uses his research as a case for preserving the environment  because these light responsive bacterium are rare and require a specific eco system. In both cases he is discussing micro-organisms, society at large, and how he relates and depends on them. He is aware of his relation with and dependence on to the smallest and the largest systems which he operates in. This is essential to leadership because so often leaders fail to see the value of all the components in their system. How do I fit into the big picture and relate to these overwhelming societal issues? How does each piece benefit me? What does each person bring to the table? It is about awareness. Great leaders have great awareness.

       The second thing he does is present some potential ethical, and even philosophical concerns that could result from his work. So often in nursing we are called on to navigate complex ethical issues and I think more than anything we are called to do what he does here. To raise awareness. I don't need to know how I feel about long term ventilation patients, or withholding medical nutrition necessarily as much as I need to be aware that it is a complex ethical issue and everyone has a right to their own opinion. I can then help others to find their own path and their own opinion by raising awareness of all the contributing factors and things to consider. What does brain death really mean? Does tube feeding necessarily increase quality or even length of life? In leadership I can raise awareness of contributing factors surrounding controversial decisions, so that while all may not agree, understanding and compromise can be reached.

In short leadership to me today is having great awareness and raising awareness in others.

(I am probably using this for my presentation topic so nobody steal it.)

Teams and Leadership

I found the topic of teams very interesting in relation to leadership and nursing. Discussed on page 225 of the text Huber delves into potential expectations the leader of a team could express to the members of the team (2010). These expectations range from communication to conflict resolution, effort in task completion and the feedback desired.

I have had the good fortune to work with both very good leaders and very bad leaders, which has given me a lot of insight into what I want in a boss or supervisor and what doesn't work very well. I think this topic of conveying your expectations to the team is essential for a good leader or a good team member in turn. An example from my current job is their expectations around sick days. Obviously someone should try to limit the times they call in sick and at the same time not transmit communicable disease to the residents. The first time I called in sick in over a year I was told that if I didn't come in I would be let go. My manager was joking and she did call around and help me find someone to cover the shift but her expectations were unclear. My job isn't incredibly difficult and I could easily manage it unless I was deathly ill, it was her expectations being unclear that made the situation difficult. Luckily I knew her sense of humor and know what a valued commodity I am for my agency and so avoided a larger issue.






Huber, D. (2010). Leadership and Nursing Care3 Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

Time Management

The topic from the text this week that I found most interesting was time management. While this isn't necessarily an area I struggle in it seems to me an area in which all students have a lot of room for improvement. Hospital stays are getting shorter and more education and cares are often brought under the umbrella of the nurses responsibility. Two powerful tools that don't really come to mind when thinking about time management are deciding what not to do and learning to say no. These may seem like cop outs but in reality they are essential tools. In a fixed amount of time only so much can be done regardless of how efficient the nurse is, by deciding what wont be done beforehand the nurse can prioritize a few non-essential items and then revisit them if time remains at the end of the shift.

Time management for me really comes down to prioritizing and re-prioritizing each time new information is available. By planning my time even briefly before each task I can become more efficient each time I work. What do I need to do with this patient? How can I group cares? While these seem simple I have a feeling that a whole new level of time management will be required as we progress into the role of nursing. Its funny to me how difficult getting a large number of patients up and ready for the day seemed at first and with simple planning and prioritizing how easy it has become.





Huber, D. (2010). Leadership and Nursing Care3 Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

Centralization

One interesting topic from our reading was the concept of Centralization vs Decentralization. Centralization is the extent to which management decisions are made at the highest levels of command versus decentralization where the decision making process is extended down through the command structure giving a higher percentage of the work force a say in the decisions (Huber. 2010). Neither an extremely centralized or extremely decentralized system tends to work well in healthcare. This is due to the limited knowledge and specialized expertise a small group at the top is capable of having in centralization or the time consumed and also knowledge deficit that occurs when all have a say in every decision. Essentially the best person to make the decision should make the decision. This requires a more decentralized or middle ground approach.

We can look to the government and recent gridlock that seems to frequently take place in congress. The great majority of people would like to see congress compromise more and get more done related to the issues we can agree upon. Unfortunately the high level of centralization prevents the public input from really reaching any government officials at the highest level. It makes me wonder if we wouldn't be better off with more power in the states individual hands. Is decentralization the answer?






Huber, D. (2010). Leadership and Nursing Care3 Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

Healing the Healthcare System

Very interesting video about using the prescription pad, the EMAR, and college students to fix the, treat first, ask questions never, mentality pervasive in our health care system. Leaders follow their Vision!

Organization of Care

     One topic from the reading that I had little to no knowledge of beforehand was the concept of Organizational Forms found in chapter 18 of the text (Huber. 2010.). Essentially Functional Form and Program Form were compared and contrasted when related to the service structure in various health-care settings. Functional Form is the grouping of work by the type of work, for instance Nurses reporting to nurse managers etc. Program form is work grouping by service provided for instance a surgical specialty units. Why can't there be both you might wonder. The large hospitals I have been to all do use both Organizational Forms to a large extent. Specialized units with independent management structure. This is called Matrix Form "people and work are organized along both functional and program dimensions" (Huber. 2010. p 413.).
     This topic was interesting to me because it plays such a huge role in the difference between a good health-care setting and a bad one. Hospitals that can manage the potential fragments in care or achieve a high level of coordination among diciplines are the hospitals that achieve the patient outcomes. My most recent experience with fragmented care was before a routine appointment to meet with a nutritionist. I sat for 45 minutes at the clinic waiting to be seen and then I had to leave to go to work. When a patient leaves instead of waiting forever for thier appointment in the HCMC health system at least it is reffered to as "Elopement". This reminds me of another term that is regularly thrown around, "non-compliant". Patient's have lives and beliefs outside of thier health-care and the more patient centered and organizational form can be the better in my opinion. Language like elopement should be altered to reflect the nature of the problem. Provider time management or scheduling error. While I understand the burden placed on the healthcare system these problems wont be adequately addressed if the language we use doesn't accurately represent the problems at hand.










Huber, D. (2010). Leadership and Nursing Care3 Management. (4th ed). Saunders an Imprint of Elselvier Inc. Maryland Heights, MO

My Blog's Purpose

        To be honest I am creating this blog to satisfy the requirements of a Nursing Leadership course but at the same time I want it to represent my actual values and beliefs. I would like to create a product that I can expand on throughout my remaining time in school and as I move forward into practice as well. What are my thoughts? How do I stand on a variety of issues? and what does leadership really mean to me? If a leader is someone with a strong voice I would like to develop my voice somewhat in this blog, during this course and as I grow into my profession. As nursing and health care are ever changing and dynamic fields both the conversation and the voices of each nurse must change too. I would like this blog to be a safe place for any and all discussion, and a place for my fellow students and I to begin to find deeper interest in our field, discussing the nursing issues that are not tested on the boards.

Check Out This Video

Awesome Video about some little known developments. Is stem cell research still so controversial?